U.S. Gets Better Control of BP

Action Points

Explain that high blood pressure is now being controlled in about 50% of the U.S. population -- a significant increase over the last 20 years.

Explain that the improvement in blood pressure control is likely due to increased awareness and treatment, rather than healthier lifestyles and nutrition.

Despite once-bleak predictions, rates of hypertension in the U.S. have remained unchanged since 1999 and more people are controlling their high blood pressure, researchers say.

Blood pressure control increased significantly over the last 20 years, rising from 27.3% in 1988-1994 to 50.1% in 2007-2008 (P=0.006), Brent M. Egan, MD, of Medical University South Carolina in Charleston, and colleagues reported in the May 26 issue of the Journal of the American Medical Association.

"Hypertension control represents the product of awareness, the proportion of aware patients who were treated, and the proportion of treated patients whose BP was controlled," they wrote. They said the improvement in BP control is not likely explained by healthier lifestyles, because obesity (a significant risk factor for hypertension) has increased over time.

A more likely reason is that obese patients are receiving more blood pressure medications, although the study did not assess this.

To assess progress in treating and controlling hypertension in the U.S. between 1988 and 2008, the researchers looked at data from the National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2008, which included a total of 42,856 adults over age 18.

Egan and colleagues found that rates of hypertension increased from 23.9% in 1988-1994 to 28.5% in 1999-2000, but they didn't change between 1999-2000 and 2007-2008, remaining constant at 29%.

The average blood pressure among patients with hypertension dropped from 143/80 mm Hg to 135/74 mm Hg during that time.

The researchers said blood pressure control improved more significantly in absolute percentages between 1999-2000 and 2007-2008, compared with 1988-1994 and 1999-2000 (18.6% versus 4.1%, P<0.001).

The finding probably reflects improvements in awareness and treatment. The authors found a significant increase in awareness (P=0.03), treatment (P=0.004), and the proportion of patients with hypertension treated and controlled (P=0.006) during the study period.

Awareness and treatment were greater in patients with hypertension ages 60 and older (P<0.001) and 40 to 59 years (P<0.001) compared with those 18 to 39, even though "older age is a key patient characteristic in treatment-resistant hypertension," the researchers wrote.

While control improved significantly across age, race, and sex groups, the prevalence of hypertension was still greater among black patients compared with whites or Hispanics (P<0.001), a finding documented by other studies, they said.

The researchers said that increases in systolic blood pressure are likely due to adverse changes in nutrition and obesity.

Among all patients, the proportion with stage 1 hypertension, prehypertension, and normal blood pressure didn't change over the course of the study.

Still, the researchers concluded that "prevalent hypertension is not decreasing toward the national goal of 16% and will likely remain high unless adverse trends in population nutrition and body mass index" are reversed or "pharmacological approaches to hypertension prevention are adopted."

In an accompanying editorial, Aram V. Chobanian, MD, of Boston University Medical Center, wrote that the 50% rate of control meets the Healthy People 2010 goal, "which even recently seemed unachievable."

Chobanian agreed that the increased use of medications among patients with hypertension is likely driving the improvement in BP control.

"The availability of a broad array of effective antihypertensive drugs with excellent tolerability has made treatment easier than in the past," he wrote, adding that adverse effects are uncommon and are less of an issue with the flow of generics into the market.

Other contributing factors could be the increased use of electronic systems and other approaches to provide feedback reminders to patients and clinicians about patient medications and appointments.

Chobanian concluded that although the findings need to be confirmed "they should be a cause for celebration, especially given longstanding concerns over failure to achieve better control of hypertension." But he cautioned that more challenges remain, including the need for programs to incorporate healthy lifestyles into daily life.

The study was limited by a small sample size among those ages 18 to 39 and the possibility of overestimation of the prevalence of hypertension when only a single physician-measured blood pressure was available.

The study was supported by grants from the National Institutes of Health and the state of South Carolina.

Neither the researchers nor the editorialists reported any conflicts of interest.

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.